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In aims to provide interconnection of publications in international scientific journals using Digital Object Identification - DOI, our editorial office incorporated the journal "Social aspects of population health" into international reference system CrossRef.
Since 2016 DOI will be assigned to all scientific articles published in our journal free of charge.

Also DOI will be assigned to all articles published in 2014 and 2015 free of charge as well

E.B. Tsybikova
Federal Research Institute for Health Organization and Informatics of
Ministry of Health and Social Development of the Russian Federation,
Moscow

Summary. The very foundations of combating tuberculosis
in every existing system of public health imply that a patient himself
bears responsibility for genuine and completed treatment, once a course
of chemotherapy has been started. The specific trait of TB course
treatment is that drug resistance developed will always be considered as
a result of poorly organized treatment of a patient with TB. The best
way to avoid development of drug resistance will be a chemotherapy-based
combined treatment at such anti-TB medical establishments that would
possess the facilities that could be easily adjusted to the clinical
form of the disease.

Aim: to identify organization-wise reasons for cases of failure in
population-based treatment for primary identified pulmonary tuberculosis
in various regions of Russia.

Methods and Materials: The structure of TB morbidity in the studied
regions of Russia was juxtaposed to the structure of the pool of anti-TB
medical establishments differentiated for their intrinsic medical
facilities. Registry and account forms of medical documentation
envisaged by Order No. 50 of the Ministry of Public Health and Social
Development of the Russian Federation from Feb.13, 2004 were used for
calculation and estimation of physical indicators under this survey. For
the estimation of the structure of the community of patients with
primary identified pulmonary tuberculosis at the destructive phase and
failed chemotherapy, a questionnaire poll concerning the results of
cohort trials of 2008 was staged in 66 regions of the Russian
Federation.

Results: In Russia in 2008-2009, the structure of the pool of
patients with primary identified pulmonary tuberculosis that had been
registered for treatment had a prominent feature of evident unbalanced
polarization between the patients - when half of them presented absence
of specific bacterial expression and destruction of pulmonary tissues,
while 27% of them were presenting just these features identified at
routine microscopy of the sputum. In 65 regions of the Russian
Federation, the proportion of patients with primary identified
destructive pulmonary tuberculosis in whom chemotherapy proved
ineffective had a multifold surpass of the normal standards of
treatment: in 40 regions it was surpassed 2-3 times, and in 25 regions -
5 times or more.

The results of questionnaire poll staged in 66 regions of in the
Russian Federation demonstrated that in the structure of the pool of
patients with primary identified destructive pulmonary tuberculosis, in
whom chemotherapy proved ineffective, more than one fourth of them
(26.4%) developed drug resistance.

Discussion: The real decline in population-based efficiency of
pulmonary TB management emerged recently in the Russian Federation was
associated with structural crisis in the system of anti-TB dispensaries
where a large-scale demolition of the 2nd line anti-TB
dispensaries had occurred as a consequence of which the remaining
clinics turned out to be totally unprepared to fulfill comprehensive
treatment of patients with primary identified destructive pulmonary
tuberculosis.

Patients with primary identified destructive pulmonary tuberculosis,
in whom chemotherapy proved ineffective, tended to enter the sub-pool of
patients with acquired tuberculosis in whom developed the most
notorious feature Ä¾ namely, the drug resistance, and this sub-pool was
to form a reservoir of infection for the rest of the population. A
tendency to provide wide hospital admission to patients with primary
identified destructive pulmonary tuberculosis with confirmed absence of
specific bacterial expression and no destruction of pulmonary tissues
still persisted in recent years, when actually these patients should
have had admittance only to dispensaries and mainly treated there on
outpatient basis or - in the last resort Ä¾ in hospital department of
ordinary anti-TB dispensaries. A dramatic rise in the need for creation
of 3rd-4th line anti-TB establishments
(practically, a hospice) proved quite obvious Ä¾ mainly due to widespread
of drug resistant pulmonary tuberculosis.

Conclusion: The main reason for organizationally-caused overall
failure in treatment of patients with primary identified pulmonary
tuberculosis in Russia was the structural crisis among anti-TB medical
establishments which has made itself quite expressed in the first decade
of the 21st century, when 2nd line anti-TB dispensaries has declined in half of territories of the RF, while 1st line anti-TB dispensaries has declined in one third of territories, and that meant a rise in a widespread of TB in Russia.